Consensus in chronic ankle instability: Aetiology, assessment, surgical indications and place for arthroscopy

Abstract

Ankle sprains are the most common injuries sustained during sports activities. Most ankle sprains recover fully with non-operative treatment but 20-30% develop chronic ankle instability. Predicting which patients who sustain an ankle sprain will develop instability is difficult. This paper summarises a consensus on identifying which patients may require surgery, the optimal surgical intervention along with treatment of concomitant pathology given the evidence available today. It also discusses the role of arthroscopic treatment and the anatomical basis for individual procedures.

Arthroscopic Anatomic Reconstruction of the Lateral Ligaments of the Ankle With Gracilis Autograft

“…Nonanatomic reconstruction techniques for the lateral ankle ligaments have been widely studied and have shown good efficacy in restoring stability of the hindfoot with good functional results. 8 However, the long-term results show postoperative loss of range of motion, recurrence of instability, and an increased incidence of degenerative changes of the hindfoot. 9 Maintenance of the full range of motion of the hindfoot has been shown to reduce the long-term risk of osteoarthritis and/or chronic pain.…”

Minimally Invasive Reconstruction of Anterior Talofibular Ligament with Partial Peroneus Brevis Tendon in the Treatment of Chronic Lateral Ankle Instability

“…The structural and functional integrity of the ATFL and CFL is the foundation of the lateral ankle stability, and lateral ankle ligament injuries involving the ATFL and the CFL are among the most frequently encoun- Approximately, 80 kinds of surgical procedures have been reported for treatment of chronic lateral ankle instability. 3,4 These techniques has been broadly divided into anatomical repair and ankle-ligament reconstruction. 9 As an anatomical repair procedure, the modified Brostrom technique is a good choice for correcting lateral ankle instability.…”

“…4,9,13,15 However, peroneus brevis have a function of supporting eversion and extorsion of the ankle. Therefore, the normal function of the ankle will be affected if we cut off the tendon completely during the operation.…”

“…2 To our knowledge, more than 80 surgical techniques have been described for reconstructing ankle ligaments and correcting ankle instability, most with 80 to 90% success rate. 3,4 We present our own modification of technique, minimally invasive reconstruction of ATFL with partial peroneus brevis tendon.…”

The Broström-Gould procedure: A case presentation and review of the literature

“…[8,9] Chronic lateral ankle instability is a diagnosis used to describe a combination of symptoms which can include recurrent sprains, pain with activities, apprehension, and even avoidance of activities. [10] The diagnosis can be made through history and physical examination alone, but imaging modalities are available. The predictive value of stress radiographs has been debated but may provide an additional source of data when the diagnosis is uncertain.…”